Jonathan Iglesias, MD

Partial disassembly at the junction to expose the internal stiff wire lets you manually control the lever and free a stuck Perclose footplate—turning a stressful moment into a controlled one. Practical, reproducible, and worth remembering. @Omar_A_Oliva pcronline.com/Cases-resource…

@farkomd @t_intheleadcoat @SriniTummala @ragsxray @kmadass @vascularis @cfbechara Very well. Done for dominant LVA w ostial stenosis and recurrent drop attacks and vertigo.

@ChengaziMD @t_intheleadcoat @smbracewell @laronecampbell @hkmccullough @IRtmke @AustinBourgeois @tarheeldylan ^^ this. Rarely needed, but comes in clutch

@smbracewell @t_intheleadcoat @laronecampbell @hkmccullough @IRtmke @AustinBourgeois @tarheeldylan I like putting a bend in back of Bentsen to give me more torque ability also

Nice illustration! Keep them coming Austin! Adding one more to the collection, a recent one. Courtesy @laronecampbell

The cholesterol wars are over. LDL won. New guidelines. Four landmark trials. An oral PCSK9 inhibitor that matches injectables. And data proving we should be treating patients we currently aren't. Here's everything clinicians need to know. 🧵

A nice example of #CERAB ! A win- win for the patient & operator! Was fun to co-scrub with my partner Dr. Nagib. How far do you raise the bifurcation, if at all? @JayMathewsMD @kmadass @SriniTummala @farkomd @SDhandMD @AmputationSuck @NickMouawadMD @KNagarshethMD @limbsalvagedr @drcostantino1 @keithppereira @ShariqShamimMD

Prolonged vs short balloon inflation — time to rethink? In CLTI: ✔ Short inflation (<1 min) works ✔ Strong clinical outcomes ✔ Minimal complications Would you change your practice? @JEndovascularT @AmbarishSatwik @World_fvs @ReneLizola @VascularNews

What should an IR physician do when you need to embolize one artery, but the origin has multiple branches? This was a challenge for Dr. Rajasekhara Ayyagari during one of his cases. In this clip, Dr. Ayyagari provides images taken during this case to visualize his thought process. For this case, he utilized protective coils, further explaining their benefits to direct embolics to target areas. Check out the full episode: youtube.com/watch?v=dKp5HQ… This podcast is supported by Guerbet. #VI611 #InterventionalRadiology #IRad #Urology #InterventionalUrology #ProstateArteryEmbolization #PAE #Embolization #ProtectiveCoiling #Coiling #Imaging #MedEd #BackTable

2 pair minimum

Overview of our equipment and technique for accessing the PA for PE thrombectomy. @SDhandMD @t_intheleadcoat @keithppereira @TheRealDoctorOs @_backtable

@t_intheleadcoat Ha! I forgot you fluoro stored that one. Clockwise then counter clockwise - works like a charm. Always a good day co-scrubbing. This patient did great.

Drs. Adam Beck (@AWBeckMD), @FrankCaputoMD, and @JamesHBlackMD examine key considerations on determining candidacy for open versus complex endovascular repair, exploring how patient risk profiles, characteristics, and anatomy influence decision-making. evtoday.com/articles/2026-…

This #JACCCaseReports case presents a novel bailout technique—extension catheter-assisted balloon anchoring—for device retrieval, and underscores the essential role of routine intracoronary imaging in preventing such complications. jacc.org/doi/10.1016/j.… #cvImaging #PCI #EPeeps

@thesurgerylife This is great- how ergonomic is the setup?

As a vascular surgeon i attest how important this is and how much i love mine (no coi)

@SriniTummala @SIRRFS @JayMathewsMD @AmputationSuck @_backtable Here’s the fix in action. Punctured the patent CFA, directed the needle about ~2 cm into the occluded SFA , sent V18 down over a CXI. Externalized through the pedal sheath. Therapy from the original retro sheath/access. Luminal crossing on IVUS. All in all about 90 minutes.

@JChurches @SIRRFS @JayMathewsMD @AmputationSuck @_backtable You a few options here. One is using EVUS at the CFA bifur and recanalize from above. Alternatively retro access and use EVUS to make sure you enter CFA at a good spot. IVUS key after crossing. Doable for sure!

“Patient wants to attempt endo first”. What’s your approach?

@JayMathewsMD @AmputationSuck @SIRRFS @SriniTummala @_backtable Rarely have the need to go larger than 5 Fr unless I’m deploying a supera at the SFA origin TBH. I’ll usually stick to the cook pedal access kit or a 4 Fr. A buddy of mine usually defaults to the 5 F which is overkill IMO

@JChurches @AmputationSuck @SIRRFS @SriniTummala @_backtable You'd probably need at least a 5/6 Slender if coming from the foot. 6/7 if you want to debulk potentially depending on the device.

@AmputationSuck @JayMathewsMD @SIRRFS @SriniTummala @_backtable Slender 5?

@JChurches @JayMathewsMD @SIRRFS @SriniTummala @_backtable I find retrograde access for scaffold deployment valuable here

@JayMathewsMD @SIRRFS @SriniTummala @AmputationSuck @_backtable I agree- CFA is to be revered. With a board full of cases I opted for something more definitive- 21G through the ipsi CFA ~ 2 cm into the SFA CTO. Sent a V18 down, after a gnarly knuckle I was able to prolapse down into the popliteal recon. True lumen the entire way on IVUS

@JChurches @SIRRFS @SriniTummala @AmputationSuck @_backtable I'd still try from above and abandon the high reentry. You can propagate the flap even if you laser. Sometimes balloon short of the origin so you can do a CART. You'll clean up the flap with the SFA stent.

@JayMathewsMD @SIRRFS @SriniTummala @AmputationSuck @_backtable Retro wire jumped out exactly at the femoral bifurcation for a few millimeters (> 5). Would you laser through the flap or attempt something else?

@JChurches @SIRRFS @SriniTummala @AmputationSuck @_backtable Stick the foot. Stop short of sfa origin. Identify hibernating numb from above. Floss. Worthwhile if decent recon distally.

No real nubbin going nearly lateral. Guesstimated where the ostia was and probed with an angled catheter for a few minutes. Opted to go pedal pretty quickly here. Crossed pretty quickly into the CFA and externalized. IVUS showed I was luminal all the way up to the bifurcation